Likelihood of left main coronary artery compression based on pulmonary trunk diameter in patients with pulmonary hypertension.

PURPOSE: In patients with pulmonary hypertension, extrinsic compression of the left main coronary artery by a dilated pulmonary trunk may cause angina, left ventricular ischemia, and sudden death. We assessed coronary artery compression in relation to pulmonary trunk diameter and other demographic, echocardiographic, hemodynamic, and scintigraphic variables. METHODS: Thirty-six patients (aged 15 to 86 years) with pulmonary hypertension, either idiopathic or associated with congenital heart disease, were enrolled. Left main coronary artery compression was defined angiographically as > or =50% obstruction associated with downward displacement of the vessel. Pulmonary trunk and aortic diameters were measured by transthoracic echocardiography. RESULTS: Twenty-six patients had angina, of whom 7 had left coronary artery compression. Compression was related to pulmonary trunk diameter (P = 0.002) and to the ratio of pulmonary trunk diameter to aortic diameter (P = 0.02). Compression was not seen at pulmonary artery diameters <40 mm; among 19 patients with values > or =40 mm, the rate was 37%. Similarly, compression did not occur at pulmonary trunk to aortic diameter ratios <1.21; among 27 patients with ratios > or =1.21, the rate was 26%. CONCLUSION: In pulmonary hypertension, noninvasive measurement of pulmonary trunk diameter may be helpful in determining the likelihood of left coronary artery compression and in selecting patients for diagnostic coronary angiography.

Origem anômala de artéria coronária esquerda. Correção concomitante à substituição valvar por insuficiência mitral / Anomulous origin of the left coronary artery. Simultaneous correction with mitral valve replacement

A four year-old boy with an anomalous origin of the left coronary artery (LCA) directly from the right pulmonary artery was reported. He had been underwent to mitral valve replacement by a St Judes no. 29, due to severe mitral insufficiency, secondary to an extensive myocardial infarction including the anterior and posterior papilary muscles, beside the implantation of the LCA in the aorta. Instead of this favorable outcome, it's emphasized the need for earlier recognition to avoid risk sequelae.

Criança de quatro anos de idade, portadora de orígem anômala de artéria coronária esquerda (ACE), diretamente da artéria pulmonar direita e que, tendo evoluido com insuficiência mitral severa, secundária a infarto miocárdico extenso com acometimento dos músculos papilares, necessitou de substituição valvar mitral por prótese metálica (St Judes n° 29), além do implante cirúrgico da ACE, no seio da aorta. Apesar da evolucão favorável, salienta-se a necessidade do reconhecimento precoce desta anomalia coronariana para evitar seqüelas de risco

Classificacao e aproximacao diagnostica / Classification and dignostic approach of congenital heart disease

O objetivo deste artigo e a classificacao e a aproximacao diagnostica das principais cardiopatias congenitas na infancia, que sao divididas em 2 grandes grupos: a) grupo das acianogenicas, no qual estao as cardiopatias que cursam com desvio de sangue da esquerda para a direita levando ao hiperfluxo pulmonar; cardiopatias com obstrucao direita ou esquerda e as anomalias congenitas de arterias coronarias; b) grupo das cianogenicas no qual estao as lesoes com desvio de sangue da direita para a esquerda, associadas a obstrucao de camaras direitas e as com mistura de sangue venoso. Sao discutidos os principais aspectos clinicos, os exames complementares e a abordagem de tratamento em cada caso